Childhood Bipolar? Parenting Advice

When you have a child with bipolar, parenting advice is never in short supply and is understandably not very welcome. However, in my practice, I spend far more time undiagnosing “the bipolar child” than I do diagnosing bipolar in children (see my previous post, “Childhood Bipolar or Something Else?”). The fact is that many children have a variety of challenges that share some characteristics with bipolar disorder, including anxiety, depression, and plain old frustration and anger. And while standard effective parenting techniques alone may not be an effective intervention with a child who may or may not be experiencing a clinical brain disorder, such techniques can certainly help.

I recently had a visit from one of my patients, Katie, and her father. Katie is about eight years old and is in treatment for anxiety and mood difficulties. As Dad slumped in the recliner in my office, Katie was building a masterpiece with K’nex. Dad appeared frustrated and angry. “She is ruining our family,” he said, referring to Katie. I guided the conversation to Katie’s recent explosive meltdown at school when her mom was running late and almost did not make it with the toy Katie needed for show-and-tell. The outburst included property destruction and trying to leave the classroom. Katie is an anxious little girl, and I suspected she had a worry about being in trouble for not having the toy or about missing show-and-tell. I asked her what had stressed her out so much that her body and brain felt out of control. Katie said, “I thought Mommy was dead and was never coming.”

We spent the rest of our time discussing Katie’s severe worries and the ways we can help her, such as increasing her cognitive therapy work, adjusting medications that she is already on, and including the school so they understand that this extreme fear may be triggering some of Katie’s extreme behaviors. During our conversation I also focused on Katie’s K’nex creation, and she was delighted with the attention and feedback over the colors and details of her art project. Katie jumped on her dad’s lap, chatting away and showing him her work. He gently pushed her away and said sternly, “Not now Katie. We are talking about your very bad behavior at school.” Katie slumped down onto the floor, threw the K’nex in the box, and started to fuss.

When Dad and I met privately I asked about his response. I wondered if he was too sad and tired about everything to engage happily with her. But he told me that, actually, he thought he should not show any positive feedback or she would misunderstand and think he was encouraging her negative behavior. He said he wanted to smile and let her know how much he liked it but he did not want to give her the wrong message. He breaks into a big grin and lets out a sigh when I give him permission to be positive and loving even in the context of working to curb negative behaviors. He, like many parents, felt he must withhold affection to make sure Katie understood the seriousness of her negative behaviors.

I love it when I can relieve a parent of the burden they feel to be harsh, neutral, or even angry when correcting a child. A lot of parenting advice relies on firm/stern tones, separation, and withholding of affection as key elements in stamping out negative behaviors. I could not disagree more. Years of work with thousands of families, and up close/personal work with my own two daughters, as well as an understanding of the neuroscience involved in parenting, proves to me that it is essential to blend connection and positive tone — delight in the children themselves — with any interventions focused on changing child behaviors. Positive “charge” and maintaining connection in your interactions with your child fires positive brain circuits in a way that increases the likelihood of successful collaboration to change behaviors. Negative tone and withholding connection fires negative circuits, increasing distress and reducing the child’s ability to engage in problem solving.

Let’s be clear that I do not intend to parent bash here. Parenting is exhausting, and there are a million interactions a day. Most are short and direct. We give many instructions effectively without having to coach them in carefully crafted loving tones and delight. But when we are working on a problem behavior — something that keeps coming up and we are trying to figure out solutions — I like to remind parents that it is OK to still treat your child like the terrific kid they are. You don’t have to withhold your delight in them to be a “good’ parent when you are talking about negative behaviors. You must be clear about the outcomes — that the behavior may even be dangerous or harmful to others, that the behavior is unacceptable, and that you are working together to change it. But delighting in your child’s positives and keeping a loving connection is not a parenting crime; it is, in fact, the best thing you can do.